Gestational diabetes

A severe increase in blood sugar during pregnancy is called gestational diabetes. Usually, after delivery, the condition normalizes and the sugar level returns to normal.

High blood sugar in a pregnant woman can cause a number of health problems for both the woman and the fetus. For example, the baby may be born large, which can lead to problems during vaginal delivery, as well as high blood sugar. However, with a course of certain therapy, pregnant women can control their blood sugar levels and give birth to a healthy baby.

Women who have gestational diabetes during pregnancy are more likely to develop type 2 diabetes later in life. Therefore, it is important to take preventive measures: maintain a healthy weight, eat a healthy diet, and increase physical activity.

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Statistics

The prevalence of gestational diabetes reaches 9.2%.

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Causes of Gestational Diabetes

During pregnancy, the placenta forms in the uterus, which acts as a link between the mother and the baby. It is the channel through which the fetus receives water and food. The placenta produces hormones that prevent insulin from controlling the mother's blood sugar levels, so her body has to produce more of it. When a pregnant woman's pancreas cannot produce enough insulin, gestational diabetes develops.

The pancreas produces a hormone called insulin, which helps to properly use sucrose from food. With such coordinated work, the blood sugar level is maintained within the normal range. During pregnancy, the placenta produces hormones that interfere with the work of insulin, which is why insulin resistance is observed. A pregnant woman develops diabetes when the pancreas is unable to produce enough insulin to maintain normal blood sugar levels.

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Risk factors for gestational diabetes

• pregnancy after the age of 25;
• history of gestational diabetes;
• birth of a large child in a breach (more than 4.5 kg);
• You were born weighing more than 4.5 kg;
• family history of type 2 diabetes (parents, brothers or sisters);
• sedentary lifestyle before pregnancy;
• obesity (body mass index greater than 30 or higher);
• racial or ethnic factors: Hispanics, Native Americans, Asians, African Americans, and Pacific Islanders are at higher risk for developing diabetes;
• polycystic ovary syndrome;
• dark rashes on the back, neck;
• taking corticosteroids;
• symptoms that foretell the development of diabetes;
• history of difficult pregnancy in the past.

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Symptoms of Gestational Diabetes

Gestational diabetes does not cause any symptoms, so a woman should take tests to confirm the diagnosis between 24 and 28 weeks of pregnancy. Sometimes surprises happen, and pregnant women are simply perplexed - how, do they have diabetes? Gestational diabetes can cause a number of health problems for the mother and the unborn child, so it is important to get tested in time to make sure everything is okay.

It often happens that a pregnant woman observes a number of symptoms of another type of diabetes, but is unaware of the disease.

Symptoms of other types of diabetes:

• increased thirst
• increased urination
• increased hunger
• blurred vision

During pregnancy, women already experience increased urination and eat more than usual, so they often ignore these symptoms.

Most women learn about gestational diabetes between 24 and 28 weeks of pregnancy, and only through blood tests. Once diagnosed, lifestyle changes such as a healthy diet, eating habits, and exercising regularly will help control your blood sugar levels. As you get further into your pregnancy, your body produces more hormones that prevent insulin from maintaining healthy blood sugar levels, increasing your risk of developing gestational diabetes. If healthy eating and exercise do not help control your blood sugar levels, your doctor will recommend insulin. If you are diagnosed with diabetes during pregnancy, this does not mean that your baby will get the disease. In most cases, women with gestational diabetes give birth to healthy babies. If you are able to control your blood sugar levels, there is no need to worry, as the chances of problems developing during pregnancy or childbirth are the same as if you did not have gestational diabetes. In rare cases, the following health problems may occur in both mother and baby:

• high blood pressure due to late toxicosis;
• large weight of the child (excess glucose promotes better growth of the fetus and accumulation of fat, so a large child can be injured during vaginal birth; if the child's weight exceeds 4.5 kg, a cesarean section is recommended);
• After birth, excess insulin causes a sharp drop in the baby's blood sugar, which is dangerous for his health; in such cases, glucose is additionally administered; newborns may also have low calcium levels, high bilirubin, and a large number of red blood cells.

Gestational diabetes usually goes away after delivery. But if it is diagnosed during this pregnancy, it may recur in subsequent pregnancies, and the risk of developing type 2 diabetes increases. According to data, more than half of women who had gestational diabetes were diagnosed with type 2 diabetes.

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Diagnosis of gestational diabetes

Almost all pregnant women undergo tests between 24 and 28 weeks. If your doctor suspects that you may have this disease, he or she will prescribe diagnostics much earlier.

Gestational diabetes is diagnosed with two blood tests. One is taken an hour after drinking a small cup of sugary drink. If the blood sugar level is very high, another longer 3-hour glucose test is done. If the blood sugar level is still higher than normal, the doctor diagnoses gestational diabetes.

Almost all pregnant women are tested for gestational diabetes between 18 and 28 weeks of pregnancy. But if your doctor thinks you're at high risk, you'll be tested much earlier.

Gestational diabetes is diagnosed with an oral glucose tolerance test. The woman drinks a small amount of a sweet drink and an hour later her blood sugar level is checked. If the level is very high, another three-hour glucose tolerance test is done. This involves fasting for three hours (you can only drink water) and then drinking a small amount of a sweet drink. Your blood sugar level is checked every hour for at least three hours. If two or more of these tests show high sugar levels, your doctor diagnoses you with gestational diabetes.

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Diagnostics during pregnancy

In gestational diabetes, the attending physician will measure the pregnant woman's blood pressure during each visit. In addition, he will prescribe various tests and diagnostics to determine the health of the baby and mother.

• Ultrasound. Diagnostics helps to determine the need for additional insulin administration, as well as to determine the weight, age, health condition and size of the abdominal cavity of the fetus. Based on the ultrasound results, the doctor prescribes treatment. If the child is too large, the doctor will prescribe insulin administration. Remember that ultrasound does not always correctly determine the child's weight and developmental anomalies.
• Non-stress test (when monitoring the fetus). During movement, the reaction of the fetal cardiovascular system is observed. Sometimes the doctor prescribes a monthly analysis of glycosylated hemoglobin (average blood sugar level over time).

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Diagnostics during labor

During labor, the doctor carefully monitors the health of the pregnant woman and the child, namely:

• fetal heart rate monitoring (to determine the baby's condition);
• blood sugar test (every few hours);

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Postnatal diagnostics

After giving birth, a woman needs to have her blood tested for sugar several times. During the first few hours after birth, the newborn's blood is also tested for sugar. One of the three days after giving birth, you will need to fast and take an oral glucose tolerance test. It is more likely that gestational diabetes will go away after the baby is born, but since you are at risk for developing type 2 diabetes, you need to take an oral glucose tolerance test 6 weeks after giving birth and take a blood test for sugar after fasting once a year. Sometimes your doctor will recommend an additional glucose tolerance test if your blood sugar is normal or slightly elevated.

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Early detection of disease

During your first visit to the doctor after you find out you are pregnant, your doctor will determine your risk of developing gestational diabetes. If you have gained a lot of extra pounds during a previous pregnancy, have been diagnosed with high blood sugar, have a family history of type 2 diabetes, and have sugar in your urine, your doctor will order testing and diagnostics right away.

Most women are tested for gestational diabetes between 24 and 28 weeks of pregnancy. You may not need this testing if:

• You became pregnant before the age of 25;
• You have not been previously diagnosed with gestational diabetes;
• no one in the family has type 2 diabetes;
• Your body mass index is less than 25;
• You are not a member of an ethnic group that is at higher risk for developing diabetes (Hispanics, Asians, African Americans, and Pacific Islanders);
• You do not have polycystic ovary syndrome.

Some pregnant women are not at risk for gestational diabetes and therefore do not need to be tested. Experts disagree on whether all pregnant women should have this type of testing. However, most doctors recommend it for safety.

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After childbirth

Although gestational diabetes will go away after the baby is born, it may reappear during the next pregnancy. In addition, in such cases (in more than half of women), type 2 diabetes develops a little later after gestational diabetes. The doctor will tell you how you need to check your blood sugar levels at home for some time. After 6-12 weeks after the baby is born and after breastfeeding has stopped, you should take a glucose tolerance test. If the results are normal, you need to have your blood tested for sugar levels every three years after a certain period of fasting. Even if your sugar levels are within normal limits, you should not forget about the possibility of developing diabetes. Stick to a healthy diet and nutrition regimen and exercise actively. The use of birth control pills containing progesterone and progestin is not a factor that provokes the development of type 2 diabetes.

Consult your gynecologist about the most appropriate contraceptives. If you are planning to have a child, you should be tested for diabetes before and during pregnancy.

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Treatment of gestational diabetes

Many women manage to keep their blood sugar levels under control by exercising and changing their diet and eating habits. These measures also prevent gestational diabetes during pregnancy in the future, and over time, type 2 diabetes. Along with this, it is necessary to regularly check the blood sugar level at home and regularly visit the doctor. In some cases, women additionally inject insulin, which replenishes the lack of insulin produced by the body.

The diagnosis of "gestational diabetes" sounds scary, but in most cases, women with this diagnosis give birth to healthy children. A pregnant woman herself should take care of the normal course of pregnancy. Treatment of gestational diabetes includes a healthy lifestyle, that is, a woman should adhere to a healthy diet and nutrition regimen, exercise regularly, and constantly monitor blood sugar levels.

The doctor will develop a special treatment plan just for you. There is no need to eat special foods, but you need to change what, when and how much you eat. In addition, you should sign up for training for pregnant women. A healthy lifestyle is the key to a successful pregnancy and childbirth, as well as the prevention of diabetes in old age. When you begin to implement these changes in your life, you will learn a lot about your body and learn to recognize its reaction to food intake and physical activity. You will be pleasantly surprised by the improvement in your well-being and the surge of energy.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

Balanced diet. Once tests have confirmed gestational diabetes, you should consult a nutritionist who will develop a healthy diet plan. They will tell you how to limit the amount of carbohydrates you eat to control your blood sugar levels and recommend that you write down everything you eat throughout the day (to track your weight trend).

Exercise regularly. Aim for at least 2.5 hours of exercise per week. You can do 30 minutes of vigorous activity 5 days a week, or split this time into 10-minute increments throughout the day. Regular moderate activity during pregnancy helps your body process insulin and maintain normal blood sugar levels. If you were inactive before pregnancy, talk to your doctor about the best way to start. Walking and swimming are the best choices for pregnant women, but you can also sign up for special training sessions for pregnant women.

Blood sugar monitoring. An important part of the gestational diabetes management program is systematic blood sugar monitoring. At home, you need to check it up to 4 times a day (before breakfast and an hour after eating). If you inject insulin, you need to test 6 times a day (before and an hour after eating). Frequent blood sugar monitoring can sometimes seem like an exhausting task, but knowing that your blood sugar level is within normal limits will help you calm down and cast aside all negative thoughts.

Monitoring fetal development and growth. Your doctor may recommend monitoring fetal movement and may also prescribe an ultrasound. If the fetus is overweight, you should administer insulin. When administering insulin, you should undergo a non-stress test (to monitor the fetal heart rate during movement). Remember that ultrasound and a non-stress test are prescribed in the last days of pregnancy even when insulin is not administered.

Regular visits to the doctor. A pregnant woman with gestational diabetes should regularly come to the attending physician for consultation. During the visits, the doctor will measure blood pressure and prescribe a urine test. The woman talks about how often and what she eats, how much time she spends actively moving and how much weight she has gained. In addition, the doctor analyzes the blood sugar level, which is determined at home.

Insulin administration. The first step in gestational diabetes is to change your diet and eating habits, as well as exercise regularly. But if, after changing your lifestyle, your blood sugar levels are significantly different from the norm (high), your doctor may prescribe insulin administration. It will help keep your blood sugar levels within normal limits and is considered harmless to the fetus.

As a rule, you can't starve during pregnancy. Doctors usually consider it normal for a pregnant woman to gain 12 kg, but if you are obese or overweight, your doctor may recommend eating less and, therefore, gaining less weight. Large women are more prone to high blood pressure and late pregnancy toxicosis.

If possible, you should breastfeed your baby. Breastfeeding is a preventative measure against obesity and diabetes in children, but during breastfeeding, you should not forget about monitoring your baby's blood sugar levels.

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Childbirth

Most women with gestational diabetes give birth vaginally, so a diagnosis of gestational diabetes alone is not a medical indication for a cesarean section. If the doctor believes that the baby will be large, he or she will order an ultrasound to determine the exact weight and size of the fetus. If the fetus is large, the doctor decides to induce labor at 38 weeks and plans a cesarean section.

• During labor and delivery, the mother and child are under the supervision of a physician.
• Blood sugar levels are checked every hour or two. If the level is high, insulin is injected into the vein; if it is low, glucose is injected.
• Monitoring the fetal heart rate and health. If the baby is large and fetal distress is observed, the doctor will order a cesarean section.

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After childbirth

After giving birth, you and your baby will still be under the supervision of specialists.

• Your blood sugar level will be measured every hour (usually it returns to normal).
• The baby will also have a blood sugar test. If you had high sugar levels during pregnancy, the baby's body will produce increased amounts for several hours after birth. Sometimes this leads to hypoglycemia (low blood sugar). In this case, the baby is given sugary water or glucose intravenously.
• The baby may have low calcium, high bilirubin, and an elevated red blood cell count.

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Drug treatment of gestational diabetes

For most women with gestational diabetes, it is enough to switch to a healthy diet and an active lifestyle to normalize blood sugar levels. If this is not enough, and if the fetus gains more weight than normal, insulin must be administered. The doctor will explain in detail how to do this.

Insulin is the only approved drug for the treatment of gestational diabetes, which is used when a pregnant woman’s body cannot control her blood sugar levels with a healthy diet and regular exercise. The amount of insulin given depends on the woman’s weight and how far along she is in her pregnancy. In some cases, the body needs more insulin in the last weeks of pregnancy because the placenta produces more of a hormone that interferes with insulin’s ability to work. Sometimes the woman is hospitalized until her blood sugar levels return to normal. Glyburide is used for type 2 diabetes, but in rare cases it is also used for gestational diabetes.

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Insulin for gestational diabetes

Insulin is usually produced by the pancreas. Its medicinal form helps the body process glucose. It cannot be taken orally because stomach acid destroys it before it reaches the blood. There are different types of insulin, depending on how quickly and how long it works: fast/long-acting/medium-acting.

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Package

Insulin is produced in small glass jars, sealed with rubber caps, containing 1000 units. It is also produced in cartridges - syringe pens with special needles. Each package contains detailed instructions for use.

How to take insulin?

Insulin is injected under the skin and sometimes into a vein, but only in a medical facility.

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Action of insulin

Insulin lowers blood sugar by helping glucose reach cells and be used as energy. Sometimes women with gestational diabetes need to take two types of insulin - rapid and intermediate-acting. Long-acting insulin is not recommended during pregnancy. Short-acting insulin lowers blood sugar and then stops working. Then long-acting insulin takes over. A combination of short-acting and long-acting insulin helps maintain blood sugar levels within normal limits before and after meals.

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Why is it used?

Your doctor will recommend insulin if diet and exercise don't help normalize your blood sugar levels, which is important for the health of both you and your baby. Gestational diabetes usually goes away after you give birth, and insulin is no longer needed.

Insulin efficiency

Currently, insulin is the only approved drug prescribed for gestational diabetes.

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Side effects

Insulin administration may result in hypoglycemia (low blood sugar).

Sugar drops very quickly - within 10-15 minutes as a result:

• insulin overdose;
• introducing it into muscle tissue rather than adipose tissue;
• skipping meals;
• excessive physical activity without proper nutrition;
• drinking alcohol, especially on an empty stomach (any amount of alcohol during pregnancy is considered dangerous to the health of the child);
• taking medications that lower sugar (some over-the-counter medications have the property of lowering blood sugar levels, so before buying any drug, you need to consult a doctor).

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What should you think about?

Insulin intake should be tailored to your needs. The development of side effects and the action of insulin depend on many factors:

• Insulin injection sites: if you inject into muscle tissue rather than into fatty tissue, the insulin will work very quickly;
• the amount of insulin administered: exceeding the dosage can lead to a sharp decrease in blood sugar;
• combinations of insulin types: the drug works faster if you take only fast-acting insulin;
• whether physical exercise was performed before the drug was administered: if an injection is made into muscle tissue that was under tension during training, the drug will enter the blood faster.

Women with gestational diabetes need to check their blood sugar levels up to 6 times a day (before meals and an hour after meals).

Check the expiration date of the drug and keep track of when the next bottle was opened. After 30 days, take the next bottle and throw away the remaining insulin.

Store your insulin box as directed.

Treatment of gestational diabetes at home

The successful course of pregnancy largely depends on you. Gestational diabetes, like other types of diabetes, cannot be cured with medications alone. Your doctor and nutritionist will give you recommendations on how to change your lifestyle to cope with the disease. Knowing all the information about this disease is the first step to a healthy pregnancy. If you know how nutrition and exercise affect your blood sugar levels, you can control them yourself, and therefore prevent many problems in the future.

Treating gestational diabetes at home involves eating a healthy diet, exercising regularly, and monitoring your blood sugar levels.

Healthy diet

A healthy diet and eating habits will help keep your blood sugar levels within normal limits. Once you have been diagnosed with gestational diabetes, you should immediately consult a nutritionist who will develop a special nutrition plan just for you. You will be advised to write down everything you eat to help control your weight. The nutritionist will also teach you how to count and distribute the carbohydrates you consume throughout the day.

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Regular physical activity

Staying moderately active during pregnancy helps your body use insulin better, which helps control your blood sugar. Often, gestational diabetes can be managed simply by exercising and eating healthy foods. Try to be moderately active for at least 2.5 hours a week. You can do 30 minutes 5 days a week, or spread out the activity over several 10-minute sessions each day.

If you were sedentary before pregnancy, talk to your doctor about the best way to start exercising. For pregnant women, for example, cycling in a recumbent position is suitable. You can enroll in a special sports group for pregnant women or start going to the pool.

If an active and healthy lifestyle helps to normalize blood sugar levels, there is no need to inject insulin. If your doctor does recommend injecting insulin, you should always have quick-acting sugary foods on hand during exercise in case symptoms of low blood sugar occur. In this case, stop exercising, check your blood sugar, and have a snack.

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Checking blood sugar levels

An integral part of gestational diabetes treatment is blood sugar control. You need to test your blood sugar 4 times a day (in the morning before breakfast and an hour after each meal). If you inject insulin, you should check your blood sugar 6 times a day (before and an hour after eating). Frequent blood sugar control may seem like an exhausting task, but knowing that your blood sugar level is within normal limits will help you calm down and cast aside all negative thoughts.

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Other important points

If a healthy diet and an active lifestyle do not help normalize blood sugar levels, your doctor will recommend injecting insulin.

• Don't try to lose weight during pregnancy if you were already overweight. Just talk to your doctor about how much weight you can gain during pregnancy.
• Your doctor may recommend monitoring your baby's movements to see if the kicks have decreased. Fetal movements typically begin around 18 weeks and will move several times a day. If you feel like you haven't felt any movement in a while, lie on your left side for 30 minutes or more. If you don't feel any movement, call your doctor.
• If you inject insulin, your insulin levels may drop to a critical level. Although this is rare in gestational diabetes, a pregnant woman should be aware of the symptoms of low blood sugar and have quick-acting sugary foods on hand.

What should be taken into account?

In most cases, a pregnant woman's blood sugar levels return to normal within a few hours after the baby is born. If you have already been diagnosed with gestational diabetes, there is a high risk of it recurring during your next pregnancy. It is also possible to develop type 2 diabetes at an older age. Switching to a healthy lifestyle during pregnancy (and following it) is the prevention of diabetes and the key to health. If you are concerned about your health or that of your child, consult a doctor.

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Gestational Diabetes: When to Seek Help?

Call emergency medical help immediately if a woman injecting insulin:

• faints or experiences symptoms of low blood sugar that do not go away after drinking a sweet drink or eating food;
• has low blood sugar (less than 50 milligrams per deciliter);
• becomes sleepy and lethargic, while the blood sugar level is less than 60 milligrams per deciliter (after measures have been taken to increase it).

See your doctor if you have gestational diabetes and:

• You notice that your baby starts to move less or stops moving altogether;
• You are taking insulin without consulting your doctor about how to control low blood sugar;
• Your blood sugar level does not rise above 60 milligrams per deciliter after taking steps to raise your blood sugar level;
• You have difficulty controlling your blood sugar levels; if you take insulin, you will also need to change your diet and eating habits;
• You have been feeling unwell for 2 days or more (excluding colds) and have had vomiting or diarrhea for 6 hours; You associate weakness and thirst with high blood sugar;
• You followed your doctor's advice but didn't feel any better; your blood sugar remains at 150 milligrams per deciliter.

You should also see your doctor if you suspect symptoms of high blood sugar: increased thirst, urinating more often than usual, increased hunger, and blurred vision.

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Observation

Over a period of time, you observe the symptoms. If your health improves, you will not need to undergo treatment. If it worsens, the doctor will decide what to do. If you are pregnant and are at risk for developing gestational diabetes or are experiencing its symptoms, you cannot delay - you need to seek help from a doctor. Observation is also not advisable if you are injecting insulin and still experience symptoms of low blood sugar that do not go away after the measures taken.

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Who should you contact if you have gestational diabetes?

Specialists who diagnose and treat gestational diabetes:

• family physician with experience in treating gestational diabetes;
• obstetrician-gynecologist.

If you need to inject insulin, you can consult an endocrinologist or perinatologist. After consulting these specialists, you can return to your attending physician. If you have been diagnosed with gestational diabetes, you should also consult a nutritionist who will help you adjust your diet and eating regimen.

Preventing Gestational Diabetes

Sometimes gestational diabetes can't be prevented. However, you can reduce your risk by maintaining a healthy weight and not gaining too many extra pounds during pregnancy. Regular exercise will help keep your blood sugar levels within normal limits.

Once you have been diagnosed with gestational diabetes, there is a high risk of it recurring in the future and developing type 2 diabetes. One of the main principles of preventing gestational diabetes is maintaining a healthy weight.

If you have had gestational diabetes in the past, avoid medications that cause insulin resistance (niacin and glucocorticoids: prednisone and dexamethasone). Birth control pills containing estrogen and progestin (low dose) do not increase the risk of developing type 2 diabetes.

A child born to a woman with gestational diabetes is at risk for developing type 2 diabetes and obesity. Breastfeeding prevents the child from gaining excess weight. As your child grows, teach him or her to eat a healthy diet and exercise, which is a preventative measure against type 2 diabetes.

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